Cactus spine injuries to the skin are usually treated by removing the visible spines and applying a topical corticosteroid. With this approach, granulomatous inflammation usually resolves in 2 to 4 months. We describe a case of a 54-year-old Caucasian woman who presented for treatment of painful cactus spine granulomas on her right hand. Unroofing the granulomatous papules and removing the cactus spine fragments under a dissecting microscope, and subsequent soaking in an antibacterial solution, resulted in rapid resolution of the granulomatous lesions.